‘Chatham University Master of Occupational Therapy Program Fieldwork I-A Fieldwork Educator Evaluation of Student Performance Student Name: Please consider each ofthe items listed below. Use the following scale to rate the student's performance foreach tem: [RATING SCALE FOR STUDENT PERFORMANCE: “The student's performance EXCEEDS the expectation fora LEVEL: fieldwork ten. Performance i frequently aioe and beyond expectations. ‘The student’ performance MEETS the expectation fora LEVEL fieldwork student. Performance is sold and consistent. “The student’ performance NEEDS IMPROVEMENT to meet the expectation for 9 LEVEL ildwork student. Work s eccasionally unacceptable. “The student’ performance fs UNSATISFACTORY and requires significant remediation to meet the expectation fora LEVEL fieldwork student. Work is {frequently unacceptable. pate: “Tiir\4 | aaa | Wes Improvement Unsatisfactory | ipl eon aon sd piney ik cE Completes assignments on time '3. ble to adjust to changes in scheduling and caseload 4. Performance is consistent with the American Occupational Therapy Association Occupational Therapy Code of Eis [AOTA, { 2010) 5. Adhores tote fieldwork ste dress code ‘6. Maintain confidentoity in ell felawork interactions and complies witha focltyconfidentaity policies and regulations (ka, | pupa. FERPA ete) me {Recognizes and manages parson sesso in postive and construe ways : cease Accepts ad follows trough on assigned responses x Responds postive to requests for stance ad works dependent appropri ote uation, y 10 Demonsvates openness to feedback nd modes benovir in response to feedback. ‘COMMENTS: : fe hak= INTERPERSONAL and COMMUNICATION SKILLS z |g 8,/95] ¢ ae| 2) § agua; ¥g 3 = a ege| ies “Terns pet or persona and car ference hough verbal interocions and non verbo ecb a [2 Recognize and demonstrates respect for personal space of cents and others Y i 7B. Appears comfortable providing appropriate physical contact to cents e 4a Adjusts verbal and nonverbal communication yl and aproach with ens ariies and/or Sta. 5 45, Usesaccurate profesional and/or lay temncony a perprate Z [1s Uses appropriate nonverbal communication se a : COMMENTS ay. ae z 5 2 i ae z aajgiiel & £5 TF are To nivel precotis,faciy pace and receires, ond bac ety rection o 18 Abe oie ond incorporate leon sft oreoutos ie mec tory, enuvorertal to sure ie 5. Uses proper body mechanics to ensure on sfey S ‘COMMENTS: 7‘COMBMITIVENT to LEARNING = a. i. g g : 3 algele8 2 7 a gg/d8 5 St TST Ee seo da ag as prom — TS Se es et ie ede Wate a ooo apnea lantern : enacts g 3 BalSs) ge ae 8) be ag ael oa ig ght ag 5 as 72, Raises relevand questions na time and place appropriate manner. 23. Considers alternative points of view during the reasoning process. 724, Identifies intervention options and is able to justify rationale 25, Able to recognize a problem; identify appropriate solutions); and offer Wess for mouifcaion. ‘COMMENTS: ad GAL perdneed fo Ae oo Requirements for passing: No more than 1 item rated as “Unsatisfactory” and no more than 2 items rated as “Needs Improvement” [rating of "Needs Improvement” or “Uneatisfactory”on any Moczed item (& 6,11, 17,18, 19 will require a review ofthe student's performance by the APWC. ‘andthe student.1 student relevant to your clinical practice/clinical question? rile surmry provides bythe tent Relat you? 3: Da yu atte Being able To use the information provided by te dent your mace? Fieldwork Site/Organization CS Qeeguihil? Hae spt Fieldwork Educators Signature/Date tudeftsSignature/Date